Instances have occurred of colic being produced by the prolonged employment of the compounds of lead inwardly in medical practice. Such cases are so uncommon that it is evident some strong constitutional tendency must co-operate. But it is in vain to deny, as some do, that the medicinal employment of preparations of lead internally is unattended with any risk whatever of slow poisoning. Dr. Billing of Mulhausen relates a case of death, apparently from the comatose affection succeeding the colic stage of poisoning with lead, in the instance of a boy of fifteen, to whom he gave acetate of lead in gradually increasing doses for six weeks, till he took two grains daily.[[1335]] Tanquerel met with a case of colic produced by 130 grains taken in fourteen days, and another occasioned by 149 grains in sixteen days.[[1336]] Sir George Baker has mentioned similar instances.[[1337]] It would even appear that metallic lead may have the same effect when taken inwardly. Thus Dr. Ruva of Cilavegno has related the case of a man who was violently attacked with the colic form of the effects of lead after taking six ounces of shot by direction of a quack for the cure of dyspepsia, and was seized again with the same symptoms six days afterwards on taking four ounces more. On the second occasion he had violent colic, great feebleness of the limbs, constant vomiting of any thing he swallowed, severe headache, and other analogous symptoms, of which he was not effectually cured for seven weeks.[[1338]] A case somewhat similar, but less severe, has been described by Dr. Bruce.[[1339]]—With regard to lead colic being excited by unguents and lotions applied to the surface of the body, Sir George Baker mentions a case of violent colic brought on by litharge ointment applied to the vagina; he adds that children have been thrown into convulsions by the same substance sprinkled on sores: and he quotes Zeller for a case where symptoms of poisoning were occasioned by sprinkling the axilla with it, as a cure for redness of the face.[[1340]] Dr. Wall, in a letter to the preceding author, mentions his having seen the bowels affected by Goulard’s extract applied to ulcers; in another paper he has given two unequivocal cases, in one of which colic was brought on by saturnine lotions applied to a pustular disease, and in the other by immersing the legs twice a day for ten days in a bath of the solution of acetate of lead:[[1341]] and lately Dr. Taufflieb of Barr observed lead colic to arise from the continued use of diachylon plaster during eleven weeks for dressing an extensive ulcer.[[1342]] Such accidents are exceedingly rare, and some auxiliary cause must have favoured the operation of the poison in the cases now noticed; for every one knows that free use is made of lead unguents and lotions, yet we seldom hear of any bad consequences.—These cases, however, will probably remove the doubts which some entertain of the possibility of lead colic being induced by the application of the compounds of lead to the sound skin in those trades which compel the workmen to be constantly handling them. At the same time it must be admitted, that in all these trades there exists a more obvious and ready channel for the introduction of the poison; because the workmen are either exposed to breathe its fumes, or are apt to transfer its particles from the fingers into the stomach with their food.—Of all exposures none is more rapid and certain than breathing the vapours or dust of the preparations of lead. But for that very reason workmen who are so exposed seldom suffer; because the greatness of the risk has led to the discovery of means to avert it, and the openness of the danger renders it easy for the workmen to apply them. Tanquerel mentions a singular case of a woman who was attacked in consequence of the fine dust of white lead ascending through chinks in the floor from a room below, where a perfumer was in the practice of grinding and sifting that substance.[[1343]]—It may be added that Dr. Otto of Copenhagen has published an extraordinary instance of fatal lead-colic, originating in the habitual use of Macuba snuff adulterated with twenty per cent. of red lead.[[1344]]
To these observations on the various ways in which lead insidiously enters the system a few remarks may be added on the trades which expose workmen to its influence. The most accurate information on this subject is contained in the work of Mérat.
He places foremost in the list miners of lead. In this country miners are now rarely affected, because the frequency of colica pictonum among them formerly led their masters to study the subject, and to employ proper precautions for removing the danger. It has been stated by Dr. Percival, and is generally thought, that the whole workmen in lead mines are apt to be attacked with the colic,—those who dig the sulphuret as well as those who roast the ore.[[1345]] If this idea were correct, it would be in contradiction with the general principle in toxicology, that the metals are not poisonous unless oxidated. But the opinion is in all probability founded on error; for, according to information communicated to me by Mr. Braid, and confirmed since by personal investigation, the workmen at Leadhills who dig and pulverize the ore, although liable to various diseases connected with their profession, and particularly to pectoral complaints, never have lead colic till they also work at the smelting furnaces. Next to miners may be ranked manufacturers of litharge, red-lead and white-lead. The workmen at these manufactories are exposed to inhale the fumes from the furnaces or the dust from the pulverizing mills. It has been chiefly among the workmen of a former white-lead manufactory in the neighbourhood of Edinburgh that I have had an opportunity of witnessing the lead colic. By a simple change the proprietor made in the process, and which will be mentioned presently, the disease was almost extirpated some years before the manufactory was given up.
Next in order, perhaps in the same class with colour-makers, are house-painters. The causes of their liability is the great quantity of the preparations of lead contained in the paints they use. It would appear that lead colic is most frequent among people of that trade in cities of the largest size. In Geneva, as I am informed by my friend Dr. C. Coindet of that place, colica pictonum is now almost unknown and never occurs among painters. In Edinburgh it is also little known among painters. A journeyman painter, a patient of mine in the Infirmary, had been seventeen years in the trade, and yet did not know what the painters’ colic or lead palsy meant. In London, according to the Dispensary reports, and in Paris, according to the tables of Mérat, many workmen of that trade suffer. I have been informed by an intelligent workman, once a patient of mine, who had been a journeyman painter both in London and Edinburgh, that the number of his acquaintances who had been affected with colic in the metropolis was incomparably greater than here. This man ascribed the difference to the working hours being more in the former place, so that the men had not leisure enough to make it worth their while to clean themselves carefully in the intervals. This appears a rational explanation. I do not know how the great prevalence of colic among painters in Paris is to be accounted for.
Plumbers, sheet-lead manufacturers, and lead-pipe makers, are also for obvious reasons apt to suffer; but as they are not necessarily exposed to the vapours of lead, and suffer only in consequence of handling it in the metallic form, it ought to be an easy matter to protect them. They themselves conceive that a very hazardous part of their occupation is the removing the melted lead from the melting pot, to make the sheets or pipes; but this operation cannot be dangerous if the melting pots are properly constructed.
A few cases of lead colic occur among glass-blowers, glaziers, and potters, who use the oxide of lead in their respective trades.
There are a few also among lapidaries and others, who use it for grinding and polishing, and among grocers and colourmen who sell its various preparations. Printers seldom suffer from the colic, but are generally thought liable to partial palsy of the hands, which is ascribed to frequent handling of the types. I have met with one case apparently of this nature.
Lead is not the only metal to which the power of inducing colica pictonum has been ascribed. Mérat has mentioned several instances of the disease occurring among brass-founders and other artizans who work with copper.[[1346]] Tronchin quotes Scheuchzer for a set of well-marked cases in a convent of monks, where the malady was supposed to have been traced to all the utensils for preparing and keeping their food having been made of untinned copper.[[1347]] The same author mentions two cases, one of which came under his immediate notice, where the apparent cause was the long-continued use of antimonial preparations internally.[[1348]] Mérat likewise found a few iron-smiths and white-iron-smiths in the lists kept at one of the Parisian hospitals.[[1349]] Chevallier alleges that colic occurs at times among money-changers at Paris, and others who constantly handle silver.[[1350]] Cases have even been noticed by Mérat among varnishers, plasterers, quarrymen, stone-hewers, marble-workers, statuaries, saltpetre-makers;[[1351]] and Tronchin enumerates among its causes the immoderate use of acid wine or of cider, checked perspiration, sea-scurvy, and melancholy. But the only substance besides lead, whose operation in producing colica pictonum has been traced with any degree of probability, is copper; and even among artizans who work with copper the disease is very rare. As to the other tradesmen mentioned by Mérat, it is so very uncommon among them, that we may safely impute it, when it does occur, to some other agent besides what the trade of the individual exposes him to; and in general the secret introduction of lead into the body may be presumed to be the real cause. Still, however, the connection of colica pictonum with other causes besides the poison of lead is upheld by so many facts, and is believed by so many authorities, that this disease cannot be safely assumed, even in its most characteristic form, as supplying undoubted evidence of the introduction of lead into the system. Dr. Burton thinks it will when the blue line at the edge of the gums is seen.
The work of Mérat contains some interesting numerical documents, illustrative of the trades which expose artisans to colica pictonum. They are derived from the lists kept at the hospital of La Charité in Paris, during the years 1776 and 1811. The total number of cases of colica pictonum in both years was 279. Of these, 241 were artisans whose trades exposed them to the poison of lead, namely, 148 painters, 28 plumbers, 16 potters, 15 porcelain-makers, 12 lapidaries, 9 colour-grinders, 3 glass-blowers, 2 glaziers, 2 toy-men, 2 shoemakers, a printer, a lead-miner, a leaf-beater, a shot-manufacturer. Of the remainder, 17 belonged to trades in which they were exposed to copper, namely, 7 button-makers, 5 brass-founders, 4 braziers, and a copper-turner. The remaining twenty-one were tradesmen, who worked little, or not at all with either metal, namely, 4 varnishers, 2 gilders, 2 locksmiths, a hatter, a saltpetre-maker, a winegrocer, a vine-dresser, a labourer, a distiller, a stone-cutter, a calciner,[[1352]] a soldier, a house-servant, a waiter, and an attorney’s clerk.—Age or youth seems not to afford any protection against the poison. Of the 279 cases, 24 were under twenty, and among these were several painter-boys not above fifteen years old; 113 were between nineteen and thirty; 66 between twenty-nine and forty; 38 between thirty-nine and fifty; 28 between forty-nine and sixty; and 10 older than sixty. These proportions correspond pretty nearly with the relative number of workmen of similar ages.—Among the 279 cases fifteen died, or 5·4 per cent.
There seems to have lately been little or no diminution in the frequency of the disease in Paris. In 1833–4–5–6, there were treated in the hospitals 1541 cases, or 385 annually; of whom one in 39½ died. And in 1839–40–41 there were 761 cases, or 252 annually; of whom one in 24½ died. Of 302 cases in 1841 no fewer then 266 were from white-lead manufactories.[[1353]]